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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 01/07/2025
Date Signed: 01/08/2025 07:59:16 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250106095138
FACILITY NAME:GARDEN OF PALMS LAFACILITY NUMBER:
197610403
ADMINISTRATOR:HIRSCH,RENAFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:130CENSUS: 107DATE:
01/07/2025
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Karla GarciaTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff do not ensure residents care plan is being followed-
INVESTIGATION FINDINGS:
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At 8:35 am, Tuesday, 1/07/25, Licensing Program Analyst (LPA) Raymond Comer, conducted an unannounced initial complaint visit at this facility to invesitgate the above allegation. LPA met with Administrator, Karla Garcia, presented official CDSS badge identification, and reason for the visit was disclosed.

At 8:45 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate the allegation, LPA received Facility resident roster, and staff roster. At 9:00 am, LPA reviewed Resident 1's (R1) file, and other documents relevant to the investigation. Between 9:30 am and 11:15 am, LPA conducted on-site interviews with three (3) Staff, and five (5) Residents.


[LIC 9099C]- Continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250106095138
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 01/07/2025
NARRATIVE
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The Reporting Party (RP) alleges that staff do not provide Resident#1's (R1) a juice beverage, that R1's legs are not elevated when sitting in his recliner, and that R1's smart watch battery is not charged for use. LPA's review of (R1's) file found summary care notes memorializing a "Care Conference" meeting which took place between the RP, the Staff Wellness Director, and the Administrator. LPA Interview with Staff#1 (S1) states that R1 is provided juice daily, that staff ensure R1's recliner is elevated, and that ensure that R1's smart watch is charged and placed on R1's arm when charging is complete.

LPA interview with the Staff#2 (S2) revealed that R1 is provided the aforementioned service, as stated in the care plan notes. Residents interviewed by LPA revealed they have no concerns with the care provided to them by facility Staff LPA toured R1's bedroom and found R1 resting comfortably in a recliner chair; R1's legs were elevated. LPA observed juice and bottled water setting on a table next to R1, and R1's smart watch was observed as activated and attached to R1's arm. Based on LPA observations, documents review and interviews with staff and residents, The allegation is deemed UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2